Paul Stanton on the need for wisdom in NHS boardrooms

Writing in the Health Service Journal (26 November 2008), Paul Stanton, former head of board development with the National Clinical Governance Support Team, believes that “Rules-based systems throttle governance – which,” he says, “by its nature, is the application of wisdom to uncertainty.” He goes on to say that he “can foresee no early end to uncertainty. Let us all, non-executives and executives alike, do all we can to ensure that wisdom prevails in the boardrooms of the NHS.”

Paul’s comments are made in the context of the global credit crunch and its impact on public sector and, particularly, NHS organisations. According to Paul, “A prudent and well-governed NHS organisation will already be planning for reduced resources and increased demand. Never has authoritative and effective governance been more important. Arguably, on a global scale, it has never been more scarce.”

He contends that “The current global crisis and the demands it will impose on local NHS organisations – alongside re-regulation (that is revised regulation – as opposed to de-regulation) under the auspices of the Care Quality Commission – should provide a powerful stimulus to align the approaches to system regulation and to organisational governance to ensure both go beyond the prescriptive rules-based “ticknology” that has so singularly failed in the private sector and increasingly blighted the NHS.”

In other words, says Paul, “regulation and governance should be principle and value based – with regulatory rules kept to the minimum that is consistent with clarity, transparency and effective enforcement in the interests of the protection of the vulnerable.”

Given Paul’s recent comments on the “confusion and muddle” in the Department of Health and NHS around the nature of governance (click here), Healthcare Governance Review wonders whether sufficient wisdom currently exists within the system to get NHS governance right.